| Background:Achalasia is an idiopathic esophageal motility disorder characterized by absent peristalsis and non-relaxation of the lower esophageal sphincter(LES).Despite its low incidence(1/100000), the disease seriously affects the quality of life of patients.Recently, peroral endoscopic myotomy(POEM), a relatively new technique for treating achalasia, has gained popularity as a less invasive mode to treat esophageal achalasia. Previous studies about POEM have focused on the average operative time, the average length of cut muscle, the average length of hospital stay, the postoperative complications, the postoperative sphincter(LES) pressure changing down and so on.Currently researches on the changing of symptoms and quality of life changes in patients after POEM is still not enough.This study aims to learn the effect of POEM on improving quality of life though assessing QOL before and after POEM.Furthermore,this study is also to learn the potential predisposing factors of achalasia though investigating part of the living conditions of some patients,since achalasia etiology is not clear.Methods: 31 patients who presented to our institution for surgical treatment of achalasia between August 2013 to December 2014 were asked to complete General Survey,Follow-up data were collected from a total of 31. Gender, age, disease duration, body mass index(BMI), education level, occupation, marital status, economic status, diet, with or without a family history of achalasia;Predisposing factors and Causes of exacerbation: depression, high work intensity, adverse events; symptoms: dysphagia, regurgitation, chest pain, weight loss;quality of life with Chinese version of SF-36, preoperatively and postoperatively at approximately 2weeks and 3months.Using SPSS l9.0 software system test data entry was used to process calculation and statistical analysis.Thus, each domain of the SF-36 was expressed as medians with interquartile ranges and was analyzed using a paired non-parametric statistical technique, the Wilcoxon signed-rank test. Other normally distributed data were analyzed using a paired t test. A p value less than 0.05 was considered statistically different.Result 1. General Information : 31 patients underwent POEM.21 males and 10 females, aged 16-71 years, mean age was 43.3 ± 13.5 years. The average course was four years and six months.BMI(Kg/m2)26.2±6.4. Education: high school or higher education accounted for 58.0%(18 cases), Occupation: manual and non-manual workers accounted for 51.7%(16 cases) and 48.3%(15 cases), respectively, Married accounted for 90 percent(28 cases), unmarried accounted for 10%(3 cases).Diet: eating spicy food accounted for 77.4%(24 cases), not eating spicy food accounted for 22.6%(7 cases). 31 patients had no family history of achalasia.Esophageal manometry: LES resting pressure was 28.1 ± 14.2mm Hg, LES residual pressure was 14.2 ± 11.3mm Hg; esophageal manometry type: type I 3cases, type II 27 cases, type III 1 cases.Four patients’ Upper gastrointestinal opacifications show typical beak sign. All 31 patients gastroscope inspection results were consistent with diagnostic standard of achalasia cardia. 2.clinical symptoms: there were significant improvements in dysphagia, regurgitation after POEM as early as 2 weeks. Whereas, The symptoms about body weight and chest pain had not been improved. there were significant improvements in dysphagia, regurgitation, chest pain, body weight after POEM as early as 3months. Eckardt grade after POEM as early as two weeks did not change significantly,but after 3 months was significantly lower rating. 3. quality of life :There were no significant improvements in health concepts such as Physiology, physical function, bodily pain, general health, energy, social function, role emotional, mental health after POEM as early as 2weeks. Whereas, There were significant improvements in health concepts such as Physiology, physical function, bodily pain, general health, energy, emotional Function as early as 3 months after POEM.4. potential predisposing factors :The patients with incentive on set accountes for 67.7%(21cases), the patients influenced by emotional factors accountes for 71.4%(15 cases), the patients with high tension job accountes for 9.5%(2cases), the patients with irregular work and rest accountes for 64.7%(1 cases), the patients had suffered adverse events accountes for 14.2%(3 cases). Exacerbation of symptoms with obvious incentives accounted for 61.2%(19 cases), emotional depression accountes for 73.6%(14 cases), work intensity accountes for 10.5%(2 cases), irregular work and rest accountes for 5.2%(1 cases), adverse events accountes for 10.5%(2 cases). There are no significant improvements in health concepts such as Physiology, physical function, bodily pain, general health, energy, social function, role emotional, mental health after POEM as early as 2weeks. Whereas, There were significant improvements in health concepts such as Physiology, physical function, bodily pain, general health, energy, emotional Function as early as 3 months after POEM.Conclusion1.There was no significant improvement on dysphagia, regurgitation after POEM as early as 2 weeks. But there was significant improvement on dysphagia, regurgitation, chest pain, body weight at the third month after POEM. Eckardt grade after POEM as early as two weeks did not change significantly,but after 3 months was significantly lower rating. 2.There was no significant improvement on QOL as early as 2 weeks. But there was significant improvement on QOL at the third month after POEM. 3. Psychological factors can induce and increase symptoms of cardia atony disease. |
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